Cambodia's immunization costing and financing situation
Macroeconomic and health system context
Cambodia’s economic growth has been increasing since 1998 and has averaged about 5% during the last few years. The country is currently undergoing fiscal reforms including strengthening revenue collection, demobilization of the military and increased investment in social sectors. It is also undergoing health reforms and is developing a sector-wide management system (SWIM), where donors and the government will commit funding to a set of goals but not institute basket funding. In 2001, per capita total expenditures on health were $29.8.
Immunization programme objectives
Cambodia’s immunization coverage began increasing in 1999 after a downward trend in the late 1990’s. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2001 was 60%. The national immunization programme’s objectives are to increase its coverage for all antigens to 80%, eradicate or control targeted diseases, introduce Hepatitis B vaccine, ensure vaccine safety, and improve the efficiency of vaccine delivery and usage.
Immunization costs and financing
In 2001, the first year of Vaccine Fund Support, Cambodia spent $2.8 million to deliver routine immunization services and an additional $0.8 million on supplementary immunization services. The programme-specific spending on routine immunization service equated to about $11 per DTP3 vaccinated child or $0.21 per capita. Spending on routine immunization increased in 2002 to $3.2 million, an increase of 14%, due to an increase in expenditures on transport and cold chain equipment. Total expenditures on the NIP in 2002 were $4.8 million.
Both the government and donors increased their contributions to the programme from 2001-2002. The percent of total expenditures paid by the government declined slightly during the two years, from 42% to 40%, respectively, but the absolute amount contributed increased during this period. The government pays mainly for some vaccines, salaries and transport costs while donors pay for other vaccines, supplementary immunization and capital costs. The main funding partners are GAVI/Vaccine Fund, UNICEF, WHO, CVP, Rotary International and JICA.
Routine immunization financing by source - 2002
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase as Hepatitis B vaccine is gradually introduced to the larger population and supplementary immunization activities are projected to continue. The average annual resource requirements during 2003-2006 for the NIP are estimated to be $6.5 million. Only about a quarter of the funding - government expenditures and Vaccine Fund contributions – is classified in Cambodia’s FSP as secure during these years. If funding classified as probable is included as well, approximately 85% of needs are covered.
During 2003-2006, the gap in funding for the NIP is on average $4.8 million each year if only secure funding is included and $950,000 if secure and probable funding is included. The average annual gap with secure and probable funding increases to $0.6 million, an increase of more than fivefold, in the post-Vaccine Fund period (2007-2009).
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the funding gap. These include: (1) increasing the national government financial contribution; (2) increasing provincial level expenditures for immunization services; (3). increasing donor funding for immunization; (4) increasing the reliability of funding for immunization at all times; (5) reducing vaccine wastage; and (6) improving the efficiency of outreach sessions.